INDIA ABROAD June 9, 2017 6 OPINION
hroughout the 2016
campaign — and for
months afterward —
Donald Trump prom-
ised that his replace-
ment for Obamacare
would provide “insurance for
everybody.” Last week’s
Congressional Budget Office
report makes clear that the
House Republican health care
bill falls well short of that goal.
But we now have a road map
for how Senate Republicans can
do better: by ensuring that more
low-income Americans can
First, some caution regarding
the C.B.O.’s numbers. The C.B.O.
is chock-full of committed and
talented public servants, but the
agency is neither omniscient nor
In 2010, when the Affordable
Care Act was signed into law by
President Barack Obama, the
C.B.O. predicted that by 2017, 23
million Americans would be
enrolled in the law’s new insurance exchanges. Only about 11
million actually are.
That’s because the C.B.O.
failed to account for how the
A.C.A.’s insurance regulations
would drive premiums up for relatively healthy individuals. A new
researchers at the
Health and Human
Services finds that
for people buying
coverage on their
have more than
doubled in the
affected have been
incomes — while
modest — were not
low enough to qualify for sufficient amounts of the A.C.A.’s
While the C.B.O. was overly
optimistic in 2010 about
Obamacare, there’s a strong case
that it is being overly pessimistic
about the new House bill, the
American Health Care Act.
In earlier reports, the C.B.O.
expressed its view that around
two-thirds of the people who
would no longer have insurance
under the House bill would voluntarily choose not to buy it,
because the bill repeals
Obamacare’s individual mandate. Under the A.H.C.A., there
would no longer be a fine for
staying out of the health insurance market.
Insurers don’t believe that the
individual mandate is having anywhere near the
effect that the
C.B.O. assigns to
it. There’s another,
more basic point:
If Americans have
to be forced to buy
don’t think that
offering them is a
good value on its
But there are
real problems with
the House G.O.P. bill, problems
that Senate Republicans must
Contrary to recent headlines,
the biggest problem with the
A.H.C.A. — one that the C.B.O.
highlighted — is not how the bill
deals with the sick. While that
part of the bill needs to be fixed,
it represents a smaller problem.
Indeed, the biggest problem
with the Republican bill — by far
— is that it fails people who can’t
afford health insurance, regardless of their pre-existing health
House Speaker Paul Ryan
insisted that the A.H.C.A. contain a federally defined, one-size-fits-all tax credit that provides a nearly uniform level of
assistance regardless of need.
Whether you’re ill or in good
health, the tax credit remains
the same. If you live in a high-
cost area or a low-cost area, the
tax credit remains the same. If
you and your spouse make
$150,000 a year, you get the
same amount of assistance as
people barely reaching the
Ryan’s insistence on uniformity means that the A.H.C.A.
doesn’t provide enough financial
aid to people who most need the
help: the near-elderly and the
working poor. That feature of
the bill would price millions out
of the health insurance market.
The Republican bill is supposed to “repeal and replace.”
But for older individuals newly
enrolled in Medicaid because of
the A.C.A., the House bill’s
replacement is virtually useless.
Republicans routinely ask the
poor to work harder to lift themselves out of poverty. But under
the A.H.C.A., those who work
longer hours or earn a raise or
take a second job to cross the
poverty line will be slapped with
a gigantic health insurance tab.
For those in their 60s, the cost of
crossing the poverty line could
exceed $10,000 a year.
This is terrible policy. But the
Senate has the ability to fix it. As
the president tweeted on
Sunday, the solution is to “add
more dollars” to the bill to support the working poor, while
eliminating subsidies for high
Hidden within the House bill
is the kernel of a solution.
Section 202 of the A.H.C.A. contains a transitional schedule of
tax credits for the years 2018 and
2019 that represents a hybrid
between Obamacare and the
Paul Ryan approach. It adjusts
the government’s level of premium assistance by age, like the
Ryan plan, while also capping
any individual’s exposure to
high premiums, like Obamacare.
If the Senate were simply to
remove the House bill’s uniform
tax credit and continue the
hybrid model past 2019 through
2020 and beyond, the bill would
most likely get a better coverage
score from the C.B.O. The Senate
would be able to direct more
financial assistance to those who
Continued on page 14
By Avik Roy
Above, Speaker of the House Paul Ryan introduces the American Health Care Act, March 7. The House passed a new version of a health care bill to replace the Affordable Care
Act after the first one failed to get enough Republican support in March. The bill still needs to pass the Senate before becoming law. Below, President Donald Trump.